Chapter 95: Substance Use Disorders

Substance Abuse Some individuals respond to stress by using harmful, mood-altering chemicals. Drug-substance that activates the pleasure center of the brain* Used as a response to stress, low self-esteem, obsessed with food, work, sex, gambling Recognizing and caring for those with addictions requires a high-level nursing assessment, nursing skills, patience, and compassion.

Chemical Abuse A maladaptive pattern of substance use Clinically significant impairment or distress with one or more of the following in a 12-month period Failure to fulfill role obligations Use that presents a danger Recurrent use-related legal problems Continued use, despite related interpersonal problems

Chemical Dependency Substance dependence or chemical dependency (CD) Tolerance and withdrawal Uses the drug in larger amounts or for a longer time than planned; unable to stop use or cut down Spends much time and energy planning to obtain and use the drug Gives up important activities, secondary to drug use Continues to use, knowing that the drug is causing problems

Chemical Dependency (cont.) Classified as Active In remission (not currently active, but still existing) On agonist/blocking therapy In a controlled environment

Theories of causes of Chemical Dependency Physical factors theory Genetic theory Emotional and psychological theories Low self-esteem and difficulties in interpersonal relations General uneasiness and dissatisfaction with life Low tolerance for frustration and tendency toward excessive and self-destructive acts Co-existing mental illness (in many cases) Dual disorders

Nature Progressive nature Defense mechanisms Denial Rationalization Projection

Management Recognition Intervention Treatment Recovery

Question Is the following statement true or false? Older adults are not at risk for substance abuse.

Answer False Research shows that over 33% of emergency department admissions and 20% of acute hospital admissions of older adults can be traced to complications related to substance abuse. Chemical dependency and alcoholism among older people are increasing public health problems. Many seniors overuse prescription medications, OTC drugs, or alcohol as a result of loneliness, depression, or confusion. Seniors often live alone, and the problem is not recognized until it has become very serious.

Nursing Care Measures Identification of the chemically dependent person Nursing data gathering Dealing with an intoxicated person in the healthcare facility

Nursing Process: Substance Abuse Assessment priorities Behavior changes Physical signs Complications with overdose Possible nursing diagnoses Planning Implementation Evaluation

Question Is the following statement true or false? A person’s frequency of drug use is the best criteria for determining whether he or she is chemically dependent.

Answer False How often and how much a person drinks or uses drugs are not always the best criteria for determining whether someone is alcoholic or chemically dependent. Rather, explore the role that drugs play in the individual’s life. Loss of control or inability to stop drinking or using is a cardinal sign of chemical dependency. If a person’s use affects their job, interpersonal relationships, or family, he or she has a substance abuse or chemical dependency.

Detoxification and Recovery The process of removing a drug and its physiologic effects from the person’s body Goals in detoxification management Comfort and safety Detoxification must occur before long-term chemical dependency treatment can begin When a person reduces intake of drugs, such as barbiturates or cocaine, the future danger of overdose exists

Motivation for CD Treatment The detoxification center The therapeutic community

Immediate Treatment in Detoxification Complete medical workup Rating scales CIWA (Clinical Institute Withdrawal for Alcohol) Withdrawal symptoms Nutrition and general health Refeeding syndrome

Long-Term Follow-up and Treatment Inpatient or outpatient treatment 12-step programs Rational recovery Dialectical behavioral therapy (DBT) Individual therapy Group therapy Health realization (HR) Family counseling After-care

Alcohol Abuse and Dependence Signs and symptoms Slurred speech, unsteady gait, confusion, and behavioral changes Breathalyzer level is 0.08 to 0.15 g/dL, and the person does not appear to be impaired. Specific disorders caused by alcohol abuse Dietary deficiencies, sequela of thiamine deficiency, cirrhosis of the liver and hepatitis, and other disorders

Alcohol Abuse and Dependence Treatment Stages of withdrawal Autonomic hyperactivity Neuronal excitation Sensory-perceptual disturbances Family considerations The codependent or enabler Family programs Medication therapy Antabuse, Campral, Naltrexone, Kudzu

Abuse of Other Substances Sedatives, hypnotics, and anxiolytic drugs GHB (gamma hydroxybutyrate) Cannabis-related drugs Narcotics Central nervous system (cerebral) stimulants Amphetamines Cocaine and related drugs Catha edulis (Khat)

Abuse of Other Substances (cont.) Hallucinogens LSD, mescaline, and “mushrooms” Phencyclidine hydrochloride Huffing of volatile substances Anabolic steroids Nicotine Aids to smoking cessation Caffeine Over-the-counter drugs and herbals

Question Is the following statement true or false? Herbal and dietary supplements can cause medical conditions.

Answer True Although herbal and dietary supplements often have beneficial effects, they can also cause or aggravate medical conditions. Herbal supplements can inhibit blood clotting, increase hypertension, adversely affect diabetes, or cause kidney/liver damage. Many of these products also have adverse effects when combined with certain prescribed drugs.

Hallucinogens Traditional psychedelics Other amphetamine-like drugs Anticholinergics Scopolamine

Special Abusers Pregnant women Adolescents Older adults Alcohol abuse Paradoxical reaction

Nurses Drugs are readily available in healthcare facilities; nurses are at high risk for substance abuse. The nurse is bound by law, the nursing code of ethics, and the pledge taken on entering nursing to report any staff person suspected of abusing drugs or alcohol.

End of Presentation